E D I T O R I A L
It does take two to tango! On the need for theory in research
on the social determinants of health
Matthias Richter
Published online: 22 May 2010 Ó Swiss School of Public Health 2010
Research on social determinants of health has witnessed vivid changes and improvements over the last years. These developments concern, for example, new possibilities of data analysis (such as dynamic or multi level modelling), the generation of new data (cohort or cross-national stud-ies) and even an increase in the political awareness of the issue in some countries. The report of WHO’s Commission on Social Determinants of Health is a new milestone in documenting many of these improvements (CSDH2008). Yet, one needs to state a strong imbalance in research on social inequalities in health. Almost all of these develop-ments refer to data-driven empirical research. The further development of theory, however, is lacking way behind other advancements in the field (Lahelma 2006). In our research we sometimes even refer to the same theoretical approaches that have first been proposed over 30 years ago, for example in the Black report. Of course, even in this field there have been improvements and progression, for example in linking psychobiological processes and aggre-gate deprivation to social inequalities in health (Marmot and Wilkinson2006). However, many of these approaches
are still largely driven by empirical data. Without any doubt, social epidemiology as well as public health in general are disciplines that strongly focus on empirical research. However, this cannot mean that the gap between empirical and theoretical work continues to increase. While it is not possible to look at the reasons of this development in detail here (due to necessary length-restrictions of an editorial), it is very obvious that the status quo in research on social determinants of health needs a change to a stronger accentuation of explanatory approaches. The full potential of a theory-driven analysis is hardly utilised (Potvin2009).
Let me illustrate this with two recent examples: First, life course approaches on social inequalities in health have attracted a lot of attention within public health research. The proposed theoretical concepts and models largely originate from epidemiology (Blane et al. 2007). This perspective was truly helpful to contribute to a better understanding of biological, behavioural and social influ-ences—from gestation to death—for health as well as health inequalities. However, all these approaches within the mainstream of life course research strongly focus on a medical risk factor concept. A theoretical foundation of the different life course models—in the sense of a developed formal theory—which goes beyond rather static assump-tions is still lacking. This is especially striking because right here a connection with theories of life span psy-chology and sociological life course research seems to be apparent (Settersten2009). This is also true for a sociali-sation theory perspective, which tries to combine approaches from these two disciplines. Singh-Manoux and Marmot (2005) used similar arguments when first trying to use approaches from socialisation theory for the explana-tion of health inequalities. Unfortunately, this perspective has seldom been considered in life course epidemiology.
This Editorial belongs to the series ‘‘Social determinants of health’’. Matthias Richter is Assistant Professor for Medical Sociology and Social Epidemiology at the Institute of Social and Preventive Medicine, University of Bern. His research interests lie in the field of explaining and reducing socioeconomic differences in health as well as international child and adolescent health research. He also has particular interests in human development across the life course and the role of socialisation for social inequalities in health.
M. Richter (&)
Division of Social and Behavioural Health Research,
Institute of Social and Preventive Medicine, University of Bern, Niesenweg 6, 3012 Bern, Switzerland
e-mail: mrichter@ispm.unibe.ch Int J Public Health (2010) 55:457–458 DOI 10.1007/s00038-010-0148-1
So far, the strength of public health (i.e. its interdisciplin-ary exchange) as well as the potential of combining different theoretical approaches has not been utilised in life course research.
A second example provides the recent discussion on the effects of welfare state regimes on health and health inequality. Several studies have been able to show that even though social democratic welfare states have the best overall population health, they do not have the lowest level of health inequalities (Lahelma and Lundberg2009). Here again the questions of a theoretical foundation as well as possible collaborations between different disciplines emerge to contribute to a better understanding of these irritating findings. It’s already been troubling to explain how education and income find their way into the human body. But figuring out how the welfare state gets under our skin is an even stronger theoretical challenge.
These are only two examples and surely other areas in the field could be indentified also showing large theoretical deficits. The question, however is, how both theoretical and empirical research learn to dance together more easily. The task of the next years will be to catch up conceptionally with the vast number of empirical findings and to underpin them theoretically. A minimal requirement is to continue combining single approaches to develop broader theoreti-cal models which can be tested empiritheoreti-cally; a more comprehensive requirement is the effective integration of the issue of social determinants of health into the overall framework of social science. (Social) epidemiology is required to make a stronger reference to social science theories while the theoretical assumptions and epidemio-logical findings on disease aetiology should be established and adapted within the sociological research. Furthermore,
it would be desirable for senior researchers to encourage their young colleagues not only to publish quantitative papers but also to participate in further development of theories. Maybe provocative theoretical contributions of younger researches are needed—just as much as brave editors are, to publish these new thoughts—in order to put theory on the agenda again. Maybe it is about time to remind ourselves that there ‘‘is nothing so useful as a good theory’’ (Lewin1935).
References
Blane D, Netuveli G, Stone J (2007) The development of life course epidemiology. Rev Epidemiol Sante Publique 55:31–38 Commission on Social Determinants of Health (CSDH) (2008)
Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. World Health Organization, Geneva
Lahelma E (2006) Health inequalities—the need for explanation and intervention. Eur J Public Health 16:339
Lahelma E, Lundberg O (2009) Health inequalities in European welfare states. Eur J Public Health 19:445–446
Lewin K (1935) A dynamic theory of personality. McGraw-Hill, New York
Marmot MG, Wilkinson RG (eds) (2006) Social determinants of health, 2nd edn. Oxford University Press, Oxford
Potvin L (2009) Yes! More research is needed; but not just any research. Int J Public Health 54:127–128
Settersten RA (2009) It takes two to tango: the (un)easy dance between life-course sociology and life-span psychology. Adv Life Course Res 14:74–81
Singh-Manoux A, Marmot M (2005) The role of socialisation in explaining social inequalities in health. Soc Sci Med 60:2129– 2133
